Chemotherapy for resectable and advanced pancreatic cancer

This article will review the pertinent data oil the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, flu orouracil (5-FU) was the standard of care for several decades until a singl e randomized trial established that gemcitabine (Gemzar) produced a greater clinical benefit response, median survival, and 1-year survival. Among the currently available chemotherapy agents, the taxanes, fluoropyrimidines, a nd camptothecins are being evaluated in clinical trials alone or in combina tion with gemcitabine. Newer agents that are not classically cytotoxic are also under investigation and hold promise for the future. In patients with locally advanced unresectable disease, chemotherapy is commonly used to sen sitize the cancer to radiation. Current investigations focus on trying to i mprove chemotherapy as a radiation sensitizer, using, for example, infusion al 5-FU and gemcitabine. Early-stage, surgically resectable patients may be nefit from the combination of chemotherapy and radiation, although more rec ent trials conducted in Europe raise some doubt. However, flaws in trial de sign do not allow firm conclusions to be drawn about the benefits of adjuva nt therapy. Both chemotherapy and chemoradiation are under further investig ation. Significant improvements in the survival of patients with pancreatic cancer will be achieved as more effective systemic therapies are developed , including agents with novel cellular targets.